急诊科医生应用床旁超声抢救不明原因休克的效果及可行性分析

目的:探讨急诊科医生应用床旁超声抢救不明原因休克的效果及可行性。方法:我院自2017-07-01开始在急诊抢救室由经过重症超声培训合格的急诊科医生应用床旁超声对急危重症患者进行救治。对不明原因休克患者的探查按照《不明原因休克急诊超声临床实践专家共识》推荐的THIRD流程进行。本文采用回顾性分析我院急诊科2016-01-01-2018-08-31收治的不明原因休克患者,其中123例由超声科医生实行床旁超声探查,称为超声医生组,159例由急诊科医生按此方案实行床旁超声探查,称为急诊医生组。对比分析两组患者诊断时间,计算急诊医生组诊断敏感性、特异性、阳性预测值、阴性预测值以及总准确率等指标。结果:急诊医生组诊断时间较超声组显著缩短,差异均有统计学意义(P0.05);急诊医生组患者敏感性、特异性、阳性预测值、阴性预测值及总准确率较高。结论:急诊科医生应用床旁超声按照THIRD流程探查不明原因休克患者,有助于快速明确诊断,诊断效率及准确性高,提倡推广应用。     

Image analysis on corneal opacity: A novel method to estimate postmortem interval in rabbits

Corneal opacity is one of the most commonly used parameters for estimating postmortem interval （PMI）. This paper proposes a new method to study the relationship between changes of corneal opacity and PMI by processing and analyzing cornea images. Corneal regions were extracted from images of rabbits＇ eyes and described by color-based and texture-based features, which could represent the changes of cornea at different PMI. A KNN classifier was used to reveal the association of image features and PMI. The result of the classification showed that the new method was reliable and effective.     

微信平台及绿色通道在急性ST段抬高型心肌梗死患者转诊无缝对接中的作用

目的探讨应用微信平台及绿色通道对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者转诊无缝对接效率的影响。方法徐州医科大学附属连云港医院于2016年7月1日启用微信平台结合绿色通道的模式对急性胸痛患者进行院前急救和转运,建立由120、急诊科、心内科以及不具备经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗能力的连云港市区及四县内各医院急诊科参与的微信群,利用微信平台传输病史和心电图资料,并开放绿色通道尽快行急诊PCI治疗,其中急性STEMI并符合条件的患者绕行急诊。本文采用回顾性分析我院2016年1月1日至2017年3月31日收治的急性STE-MI并行急诊PCI治疗患者的临床资料,将应用微信平台及绿色通道之前170例(2016年1月1日至2016年6月31日)患者设为A组(对照组),将应用微信平台及绿色通道之后339例(2016年7月1日至2017年3月31日)患者设为B组(观察组),对比分析两组首次医疗接触-球囊扩张(FMC-to-B)时间、入门-球囊扩张(D-to-B)时间、PCI治疗成功率、平均住院时间、人均住院费用、院内病死率等指标。结果两组PCI治疗成功率、住院时间及院内病死率比较,差异均无统计学意义(P0.05);而首次医疗接触-球囊扩张时间和入门-球囊扩张时间均较微信平台及绿色通道应用前显著减少,住院费用减少,差异均有统计学意义(P0.05)。结论微信平台和绿色通道的应用有助于急性STEMI患者的无缝转诊对接,明显缩短首次医疗接触-球囊扩张时间和入门-球囊扩张时间,提高救治效率。     

细胞凋亡在雷公藤甲素所致大鼠急性肾损伤中的作用及其发生机制

目的观察雷公藤甲素所致大鼠急性肾损伤情况,研究细胞凋亡在雷公藤甲素所致大鼠急性肾损伤中的作用及其发生机制。方法大鼠分别单次ip给予雷公藤甲素1、2 mg/kg,给药后48 h心脏采血,检测血浆尿素氮(BUN)与肌酐(Scr)水平;肾脏HE染色,光镜下观察肾组织形态学改变;应用原位末端转移酶标记法(TUNEL)检测肾组织细胞凋亡情况;利用免疫组织化学染色法结合计算机图像分析技术检测肾组织内凋亡相关蛋白的表达情况,并利用RT-PCR技术测定肾组织内凋亡相关蛋白调控基因的表达。结果雷公藤甲素2个剂量组均可见大量肾小管上皮细胞凋亡,且高剂量的作用显著大于低剂量,细胞凋亡与肾功能改变相关;肾组织中Bax、Bid、Bad、Fas以及FasL蛋白表达明显增多,且呈剂量依赖性,而Bcl-2的表达未见明显改变。结论一次性ip大剂量雷公藤甲素会在短时间(48 h)内造成严重的肾损伤,肾小管上皮细胞凋亡是雷公藤甲素所致大鼠急性肾损伤的重要组织学基础之一,且Bcl-2家族以及Fas/FasL在雷公藤甲素诱导的肾小管上皮细胞凋亡的过程中起重要作用。     

雷公藤甲素诱发大鼠急性肾损伤的机制

目的:观察雷公藤甲素对大鼠肾脏的急性毒性作用,并探讨其发生机制.方法:将雄性SD大鼠随机分为1个对照组和2个实验组,对2个实验组大鼠给予腹腔注射剂量分别为1,2 mg· kg-1的雷公藤甲素,对照组大鼠则给予相当量的空白对照液.注射后48 h将所有大鼠处死,采集心脏血液并取出双侧肾脏,检测血清尿素氮(BUN)与肌酐(Cr)含量,观察HE染色切片上肾组织形态学改变情况;应用原位末端标记法(TUNEL)检测肾组织细胞凋亡情况;测定肾组织内SOD,GSH-Px活性以及MDA含量.结果:一次性大剂量注射雷公藤甲素可在短时间内对大鼠肾脏造成严重损伤,剂量越大越显著;经雷公藤甲素处理后,肾组织中SOD与GSH-Px活性明显降低,而MDA含量则明显升高,且均与肾脏的损伤程度密切相关.结论:肾脏是雷公藤甲素急性毒性作用重要的靶器官,氧化应激在雷公藤甲素对肾脏造成的毒性损害中发挥了重要作用.     

Role of reactive oxygen species in triptolide-induced apoptosis of renal tubular cells and renal injury in rats

This study investigated the role of reactive oxygen species(ROS) in the pathogenesis of triptolide-induced renal injury in vivo.Rats were randomly divided into 4 groups(n=5 in each):triptolide group in which the rats were intraperitoneally injected with triptolide solution at a dose of 1 mg/kg of body weight on day 8;control group in which the rats received a single intraperitoneal injection of 0.9% physiological saline on day 8;vitamin C group in which the rats were pretreated with vitamin C by gavage at a dose of 250 mg/kg of body weight per day for 7 days before the same treatment as the control group on day 8;triptolide+vitamin C group in which the rats were first subjected to an oral administration of vitamin C at a dose of 250 mg/kg of body weight per day for 7 days,and then to the same treatment as the triptolide group on day 8.All the rats were sacrificed on day 10.Blood samples were collected for detection of plasma creatinine(Pcr) and plasma urea nitrogen(PUN) concentrations.Both kidneys were removed.The histological changes were measured by haematoxylin-eosin(HE) staining.The production of ROS was determined by detecting the fluorescent intensity of the oxida-tion-sensitive probe rhodamine 123 in renal tissue.Renal malondialdehyde(MDA) content was meas-ured to evaluate lipid peroxidation level in renal tissue.TUNEL staining was performed to assess apop-tosis of renal tubular cells.Renal expression of apoptosis-related proteins Bcl-2,Bax,Bid,Bad,Fas and FasL,as well as corresponding encoding genes were assessed by Western Blotting and real-time PCR.The results showed that triptolide treatment promoted the generation of a great amount of ROS,up-regulated the expression of Bax,Bid,Bad,Fas and FasL at both protein and mRNA levels,as well as the ratio of Bax to Bcl-2,and caused the apoptosis of renal tubular cells and renal injury.However,pretreatment with an antioxidant,vitamin C,significantly reduced the generation of ROS and effectively inhibited the triptolide-induced apoptosis of renal tubular cells and renal injury.It was concluded that ROS plays a critical role in triptolide-induced apoptosis of renal tubular cells and renal injury.The protective administration of vitamin C may help alleviate triptolide-induced renal injury and nephrotoxicity.     

细胞凋亡在雷公藤甲素所致大鼠急性肾损伤中的作用及其发生机制

目的 观察雷公藤甲素所致大鼠急性肾损伤情况,研究细胞凋亡在雷公藤甲素所致大鼠急性肾损伤中的作用及其发生机制。方法 大鼠分别单次ip给予雷公藤甲素1、2 mg/kg,给药后48 h心脏采血,检测血浆尿素氮（BUN）与肌酐（Scr）水平;肾脏HE染色,光镜下观察肾组织形态学改变;应用原位末端转移酶标记法（TUNEL）检测肾组织细胞凋亡情况;利用免疫组织化学染色法结合计算机图像分析技术检测肾组织内凋亡相关蛋白的表达情况,并利用RT-PCR技术测定肾组织内凋亡相关蛋白调控基因的表达。结果 雷公藤甲素2个剂量组均可见大量肾小管上皮细胞凋亡,且高剂量的作用显著大于低剂量,细胞凋亡与肾功能改变相关;肾组织中Bax、Bid、Bad、Fas以及FasL蛋白表达明显增多,且呈剂量依赖性,而Bcl-2的表达未见明显改变。结论 一次性ip大剂量雷公藤甲素会在短时间（48 h）内造成严重的肾损伤,肾小管上皮细胞凋亡是雷公藤甲素所致大鼠急性肾损伤的重要组织学基础之一,且Bcl-2家族以及Fas/FasL在雷公藤甲素诱导的肾小管上皮细胞凋亡的过程中起重要作用。